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Where looking good is understood!
MAY/JUNE NEWSLETTER
Body Art
This month’s newsletter will discuss body art, specifically piercings and tattoos. And we’re not talking about the short man with the funny voice on Fantasy Island. The purpose of this newsletter is to stimulate your brain regarding the medical aspects of a piercing or a tattoo.
Body Piercings or Slow Speed Lead Therapy
Piercings of various parts of the body have occurred for ages. The piercings range from simple, such as the ear lobe to complicated, for example the genitalia. One of our favorites is the individual who takes on a cat image complete with whiskers piercing the upper lip.
When choosing someone to pierce (or tattoo) your body, choose an individual with a basic knowledge of anatomy so that a major artery or nerve is not pierced. An understanding of infection, sterilization and aseptic technique is a must, as well as the use of surgical stainless steel. Common reactions when metal is used for a piercing include allergic reactions, most commonly, contact dermatitis. Contact dermatitis can occur with stainless steel. Piercings take various times to heal. The tongue takes approximately four to six weeks. Most wounds from piercings will attempt to close if the stud is removed for any length of time. The piercing will leave a scar.
Location of a piercing should be taken into consideration. Piercing an earlobe is usually benign. Piercing the cartilaginous portion of the ear can create problems, as cartilage receives nutrients from the tissues that cover it. Therefore, cartilage infections are difficult to treat and can result in a deformity due to loss of cartilage. Tongue piercings can cause airway obstruction due to swelling or infection. Nipple piercings can result in chronic recurrent abscesses due to the multiple ducts affected even after the nipple ring has been removed. Piercings that hang from the body can be easily ripped out. The tract through an earlobe can stretch out over time due to heavy earrings.
Infections due to piercings can be simple or life threatening. Keep in mind that you have violated the skin and have created an entrance site for bacteria to invade the body. If your immune system is stressed and doesn’t respond appropriately, then the perfect situation is created for an infection.
Infectious agents reported in the literature associated with piercings include Hepatitis B virus, tetanus and TB. Staphylococcus aureus is the most common infectious agent reported with piercings. Pseudomonas infections have been reported with ear piercings and can require removal of excessive dead tissue making this infection prone to scarring and deformities. The most serious infectious complications associated with piercings include joint infections, toxic shock syndrome and heart valve infections. Anyone who takes antibiotics prior to dental work should not have a piercing. We would not advise a piercing for anyone with a prosthetic device in their body or anyone with an abnormal heart valve. There is no way to predict who will end up with a serious infection other than the obvious, for example, an individual with immunosuppression due to drugs, infections, or genetics. No documented case of HIV transmission has been associated with a piercing. The majority of infectious complications are avoided by using sterile technique and instruments.
Tattoos--- Boss the pain, the pain!
The word tattoo is a Tahitian derivative meaning ‘to mark something.’ Tattooing goes back to ancient cultures. Tattoos can be traumatic (pencil lead), medical, decorative or an initiation rite. Medical tattooing is a great way to return pigment to hypopigmented skin. The depth that the ink is placed in the skin determines whether the tattoo will fade.
Infectious risks for tattoos are similar to piercings. Choose an artist with knowledge of aseptic technique and who uses single-use instruments and single-use inks. If the instrument is not single-use it must be autoclaved.
The saying goes that tattoos are cheap and easy to acquire, but expensive and hard to remove. It has also been said that a tattoo is forever which reminds us of an old joke: What is the difference between love and Herpes--- Herpes lasts forever! Most individuals plan to keep their art work permanently. For those who don’t, technology may be able to help you in the near future and is discussed in a paragraph below. Keep in mind that tattoos age with the skin. They fade with time as well as distort with laxity. This means the colors will not be as brilliant and the borders blur. Sun exposure and smoking age the skin as well as the tattoo. Amateur tattoos are usually harder to remove than professional tattoos because the depth of ink placement in the skin is variable.
Q-switched lasers are the tool of choice for tattoo removal. This laser has a very short pulse width- nanosecond versus the more common millisecond. The ink in the dermal skin cells absorbs the short, high intensity pulse which disrupts the cell and releases the ink. The immune system is stimulated and the ink and cellular debris are picked up and removed from the body by macrophage immune cells. Paradoxical darkening can occur if the inks contain metallic pigments like ferrous oxide or titanium dioxide. Black and blue colors are the easiest to remove with green, red and yellow being more difficult. As with any laser based procedure, scarring and pigmentary changes can occur.
Since laser removal is difficult at best with the current inks used in tattoos, a group of physicians/scientists decided to approach the problem from the ink side of the equation. Inks used for tattooing are not FDA regulated and some inks have been known to contain carcinogens and heavy metals. This group is developing inks that are safer for the body. An example is an orange ink made from beta carotene. These biocompatible inks are being packaged in clear polymer shells of polymethylmethacrylate (PMMA or “bone cement”). The ink encapsulated spheres are then placed in the skin using standard methods and techniques. When it is time to remove the tattoo the laser energy disrupts the polymer shell with the ink being released to be absorbed and eliminated by the body. The end result should be a single laser treatment to remove a permanent tattoo. The group is also developing an ink encapsulated polymer shell that will dissolve over time and release the ink for a time dependent self destructing tattoo. These tattoo products are still in the developmental and testing stages. Their price and acceptance among tattoo artists remains to be seen. For more information go to www.freedom2ink.com.
We apologize to those expecting a May newsletter but the newsletter muse was recovering from great weather, fun and mojitos in Florida. We have also decided to change the newsletter to a bi-monthly publication. Any reader is welcome to submit a topic of interest to us at info@integratedskin.com. Let us know what topics you want covered!
Reminders
Due to additional commitments Donetta Taylor will only be available on Friday afternoons for appointments. If you need an appointment at another time please contact the office at 816-505-5550 or email the office at info@integratedskin.com with the date, time, procedure and ISS will try to get your request scheduled.
Our monthly newsletter has drawn to a close. Check out our website at www.integratedskin.com. If you would like to be removed from our mailing list notify us at info@integratedskin.com (send your email address in a separate message- a reply to this Newsletter will not contain your email address).
Sincerely,
John Carter, MD, Julianne Mazurek, MD
Donetta Taylor and Jennifer Pray, Aestheticians
Integrated Skin Solutions
7424 NW River Park Drive (Hwy 9)
Parkville, MO 64152-5028
816.505.5550
Fax 816.505.4550
www.integratedskin.com
Questions or comments- info@integratedskin.com
